Pediatric Depression and Suicide

Question 1

Risk Factors for Depression

Answer 1

Personal or FHx of depression or bipolar

Suicide related behavior

substance abuse

other psych illnesses

SIgnificant psychosocial stressors (family crisis, abuse, neglect, trauma)

Question 2

What is a useful screening interview tool if sx of a pt lead you to believe they may have depression?

Answer 2

HEADSS

H-home 
E- education, employment 
A- activities 
D- drugs
S- sexuality 
S- suicide/depression

Question 3

What is the DSM5 criteria for Dx of Depression

Answer 3

-includes at least 5 of the following sx during the same 2wk period & at least one of the sx needs to be depressed mood or anhedonia.

-sleep disturbance
-weight change, appetite disturbance, or failure to achieve expected weight gain
-decreased concentration or indecisiveness
-suicidal ideation
-psychomotor agitation or retardation
(agitation; revved up, retardation; slower to derive at an answer)

• fatigue or loss of energy
• feelings of worthlessness or inappropriate guilt

*sx are not d/t a medical condition or other psychiatric disorder or substance use.

Question 4

Depressive Sx in children and pre-pubertal youth

Answer 4

Somatic complaints = belly pain, HA, nausea

psychomotor agitation

Mood-congruent hallucinations

School refusal

Phobias, separation anxiety/increase in worrying

Question 5

Depressive Sx in children and post-pubertal youth

Answer 5

low self-esteem, apathy, boredom

substance use

change in weight, sleep or grades

psychomotor depression/hypersomnia

Aggression/antisocial behavior

Social withdrawal

Question 6

What are the signs of depression? (SIGECAPS))

Answer 6

S- sleep disturbance 
I- interests 
G- Guilt 
E- energy 
C-concentration problems 
A- appetite change 
P- pleasure (decreased) 
S- suicidal thoughts or action

Question 7

What are some suicidal behaviors in children and teens?

Answer 7

• expressing self destructive thoughts
• drawing morbid or death-related pictures
• using death as a theme during play
• listening to music that centers around death
• playing video games that have self-destructive themes.
• giving away possessions

Question 8

What are some features that put teens at high risk for suicide?

Answer 8

SAD PERSONS

+ FHx of 1st degree relative who committed suicide**

Question 9

What is SAD PERSONS

Answer 9

S: sex (females attempt more,  males complete more)* 
A: age, over 16 
D: Depression and  comorbid conduct disorder, impulsive,aggresssion/anxiety 
P: previous attempts* 
E: ETOH or other substance abuse. 
R: rational thinking lost, psychotic
S: social support lacking*
O: Organized plan** 
N: no significant other  
S: sickness or stressors

Question 10

Initial Management of Depression

Answer 10

• education; recurrent and what the tx options are
• Treatment plan with pt and family (meds and set goals)
• Establish relevant links with the mental health resources in the community (peer support groups)
• Safety plan

Question 11

Treatment of Depression

Answer 11

-prescribe regular exercise or leisure activities

Cognitive Behavioral Therapy (modify the thoughts of the patient to change their behaviors)

Interpersonal psychotherapy

SSRIs

• Fluoxetine (Prozac) (8yo and up)
• Escitalopram (Lexapro) (12yo and up)

Follow up with pts every 2wks at first, once on maintenance dose follow up once a month

Question 12

Pharmacotherapy for Depression:

• how long is tx continued?
• how long does it take to see a response from SSRIs?
• which SSRI is used first line tx ?
• Can you abruptly stop using SSRIs?
• what combination therapy has the best response to tx?

Answer 12

This is not a medication they will take for 1 month and then go off of it, you continue the med for 6-12mo after the remission of depression sx. If taken off too soon they have higher risk of relapse.

-4-6wks for response to SSRIs

Prozac (Fluoxetine)

DO NOT abruptly stop using SSRI’s, they need to be tapered down

CBT or IPT PLUS meds have better response to treatment

Question 13

Fluoxetine (Prozac)

• dose
• what is the effective dose?
• What is the max dose?
• benefits of this drug

Answer 13

Dosing: 10mg for 1-2wks and then bump up to 20mg for 4-6wks to assess for efficacy before increasing the dose.

Effective dose is 20mg

Max dose is 60mg

Benefits:
-long half life, less withdrawal sx

Question 14

Lexapro (Escitalopram)

• dosing
• effective dose?
• max dose?

Answer 14

Dosing; 5mg daily

Effective dose 10-20mg

Max dose 20mg

Question 15

Common SSRI SE?

Answer 15

• HA
• GI upset
• insomnia
• agitation
• anxiety

less common…

• dry mouth
• constipation
• sweating
• sexual dysfunction*
• irritability
• disinhibition
• appetite changes
• rash
• serotonin syndrome
• akathisia
• hypomania
• discontinuation syndrome.

Question 16

SSRI BBW

Answer 16

• increased suicidality risk in children, adolescents, and young adults with major depressive or other psychiatric disorders.
• Weigh risk and benefits